Lecture 14 Multiple Sclerosis Flashcards
What part of the CNS does MS affect
White matter
Demyelination caused by inflammation of the myelin
What is the age of onset of MS
34 years
20-50 years
What is the prevalence amongst genders
Women twice as likely to develop it
Symptoms that occur during relapse
Optic neuritis Sensory symptoms Limb weakness Diplopia Vertigo/ataxia Bilateral motor and sensory symptoms Bladder involvement
Describe the symptoms of Optic Neuritis
Sub-acute visual loss Pain in moving the eye Colour vision disturbed Initial swelling of optic disc Optic atrophy Relative afferent pupillary defect
Define Myelitis
Inflammation of the spinal cord can be partial or transverse
Describe the symptoms of myelitis
Hyperaesthesia
Weakness/UMN changes below level
Bladder and bowel involvement
Pins and needles around area
What is the mechanism of demyelination
Auto immune process
Activated T cells cross blood brain barrier
Define Clinically isolated syndrome
A first episode of neurological symptoms lasting at least 24 hours
What are risk factors of relapses
Underlying infections
First 3 months post partum
What leads to progression of disease
Axonal loss leads to disease progression and development of persistent disability
What is seen on an MRI when there is axonal loss
Black holes
Cerebral atrophy
Describe the progressive phase
Accumulation of symptoms and signs
Demyelination in the hypothalamus leads to what
Temperature sensitivity
What would you see on examiantion
Afferent pupillary defect Nystagmus or abnormal eye movement Cerebellar signs Sensory signs Weakness Spasticity Hyperreflexia Plantars extensor
Name 3 types of MS
Relapsing remitting
Secondary progressive
Primary progressive
Describe the presentation of primary MS
Primarily involves spinal cord Difficulty walking No relapses Bladder symptoms UMN lesion pattern
How is MS diagnosed
Clinical(Posers criteria) or MRI (Macdonald criteria) used
During a MRI with Gadolinium what is visible
New active lesions
During a MRI with no Gadolinium what is visible
Lesions from old scars
What are the DDx of MS
ADEM SLE Sarcoidosis Vasculitis Lyme Disease TB Adrenoleucodystrophy
Name DDx for Optic neuritis
Neuromyelitis optica Sarcoidosis Iscahemic otic neropathy Toxic/drugs/B12 defieciency Wegners granulomatosis Local compression Lebers hereditary optic neuropathy Infection- TB HIV
Differential diagnosis for Myelitis
SLE Neuromyelitis optica Darcoidosis Infection (HIV, TB, Mycoplasma) Tumour Paraneoplastic process Stroke
What other infections can be carried out to investigate MS
Lumbar puncture
Visual/somatosensory evoked response
Bloods to exclude inflammatory conditoins
CXR
